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Background Acute flaccid myelitis is characterized by acute-onset flaccid limb weakness with predominantly gray matter lesions in the spinal cord spanning one or more segments. Rates of full recovery are poor, and there is no standard treatment or definitive cause. Methods This is a retrospective review of children diagnosed with acute flaccid myelitis in Texas during 2016. Patients were identified through a Texas collaborative of six hospitals in four major metropolitan areas. Data abstraction included health history, illness presentation, medical treatments, laboratory studies, imaging data, recovery, and ability to perform activities of daily living up to approximately two years from illness onset. Results Among all sites, 21 patients met inclusion criteria. Treatments varied with the most common being intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. No differences were seen in response to medical treatments. A potential etiology was found in 12 (57%) cases, including four with enterovirus D68. Five cases recovered fully. Of the 16 patients without full recovery, abilities ranged from (1) able to perform all activities of daily living for age independently (n = 5), (2) mild deficits (n = 5), and (3) substantial reliance on caregivers for activities of daily living (n = 6). Conclusion Many reports describe symptoms and outcomes of acute flaccid myelitis, but limited data are available on long-term functional outcomes. We were unable to make a strong case for any single cause or treatment modality. Fortunately, the majority of patients (15, 71%) were able to perform activities of daily living with complete independence or only mild deficits.

The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy. We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses. We present the case of a 12-month-old who underwent instrumented occipitocervical (OC) fusion in the setting of traumatic atlanto-occipital dislocation (AOD). Occipitocervical (OC) arthrodesis is obtainable in very young infants and children. Surgical approaches are variable and use a combination of autologous grafting and creative screw and/or wire constructs. The heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management.

Intractable epilepsy may have a more severe effect on children in comparison to adults because the motor, sensorial, and cognitive functions of children are still undergoing development. For this same reason, however, children maintain a greater potential for recovery from intractable epilepsy because of the remaining cerebral plasticity. Thus, after 2 unsuccessful antiepileptic medications, surgical intervention is recommended. Pre-surgical localization of the epileptogenic zone increases seizure-freedom post-surgery by 200% to 300%. Single-photon emission computed tomography (SPECT) is commonly used, with magneto-encephalography (MEG) and electroencephalography (EEG), to localize the epileptogenic zone, because it localizes cerebral blood flow. There is limited research in the efficacy of SPECT localization in pediatric pharmacoresistant epilepsy. Therefore, the objective of this study was to determine the efficacy of SPECT in it’s ability to localize the epileptogenic zone in laser ablation cases of pediatric pharmacoresistant epilepsy. Out of 122 SPECTs conducted at Dell Children’s Medical Center from July 2010 to January 2015, 12 underwent laser ablation. In the 12 cases of laser ablation, SPECT displayed more sensitivity and specificity than EEG and more specificity than MEG when held against the laser ablation outcomes. This study further proves that SPECT is efficacious in epileptogenic zone localization of pediatric pharmacoresistant epilepsy.

MRI-guided thermal ablation is a relatively new technique utilising heat to ablate both tumours and epileptogenic lesions. Its use against epilepsy offers some patients a new and relatively safe way of reducing or aborting seizures. Most cases of MRI-guided thermal ablation have been performed in patients with isolated lesions. Placement of depth electrodes prior to laser ablation has been rarely performed. We present a case with bilateral independent lesions traversing eloquent cortex, which, after sampling for seizures and successful ablation, retained normal function. The patient is, to date, seizure-free.

The average longevity of hip replacement devices is approximately 10–15 years, which generally depends on many factors. But for younger generation patients this would mean that revisions may be required at some stage in order to maintain functional activity. Therefore, research is required to increase the longevity to around 25–30 years; a target that was initially set by John Charnley. The main issues related to metal-on-metal (MoM) hip replacement devices are the high wear rates when malpositioned and the release of metallic ions into the blood stream and surrounding tissues. Work is required to reduce the wear rates and limit the amount of metallic ions being leached out of the current MoM materials, to be able to produce an ideal hip replacement material. The most commonly used MoM material is the cobalt-based alloys, more specifically ASTM F75, due to their excellent wear and corrosion resistance. They are either fabricated using the cast or wrought method, however powder processing of these alloys has been shown to improve the properties. One powder processing technique used is spark plasma sintering, which utilises electric current Joule heating to produce high heating rates to sinter powders to form an alloy. Two conventionally manufactured alloys (ASTM F75 and ASTM F1537) and a spark plasma sintered (SPS) alloy were evaluated for their microstructure, hardness, tribological performance and the release of metallic content. The SPS alloy with oxides and not carbides in its microstructure had the higher hardness, which resulted in the lowest wear and friction coefficient, with lower amounts of chromium and molybdenum detected from the wear debris compared to the ASTM F75 and ASTM F1537. In addition the wear debris size and size distribution of the SPS alloy generated were considerably small, indicating a material that exhibits excellent performance and more favourable compared to the current conventional cobalt based alloys used in orthopaedics.

Metallic implants are known to have higher wear rates compared to ceramic. This causes more wear debris to be produced and results in the release of toxic metal ions to the surrounding areas. The strengthening mechanism in cobalt based cast orthopedic alloys depends upon carbides present in the microstructure, but these cause problems when dislodged between articulating surfaces, accelerating wear by abrasion and fretting. Thus, in order to improve the performance of these implants a novel method of processing the alloys, namely by spark plasma sintering (SPS) of fine powders, has been used as it generates hard oxides and not carbides in the microstructure. The oxide in the SPS processed alloy is identified as chromium oxide formed by a redox reaction between cobalt oxide found on the surface of cobalt particles and chromium. The oxygen associated with the cobalt powder is displaced and combines with the chromium during SPS. This oxide in the microstructure of the alloy can be more beneficial than carbides due to its higher hardness, resulting in lower wear rates and less wear particles. With the oxide in the microstructure, the hardness of the alloy becomes closer to that of ceramics. Also its lower density enables the alloy to be lighter. The chemical stability of the oxide ensures that it remains intact and due its insolubility in water, no carcinogenic or toxic reactions will occur.

Background This is a multisite study of cases of acute flaccid myelitis (AFM) in Texas during the year 2016 among 6 children’s hospitals. AFM is a newly recognized and poorly understood disease. Information related particularly to pathogenesis, treatment, and recovery are lacking. Methods Children age 0–18 years admitted with AFM defined as acute onset limb weakness with spinal cord lesions on MRI primarily involving gray matter during January 1–December 31, 2016, were reviewed. Abstracted information included demographics, presentation, laboratory findings, treatments, and long-term outcomes up to 18 months after onset of weakness (range 3.5–18 months; median 15 months). Results 22 patients from 5 hospitals were included. Median age was 4.9 years. Upper extremity involvement was common (77%), with all extremities being involved in 36%. Enterovirus D68 was identified in 3 cases. Other pathogens identified included human parechovirus (n = 2), human herpesvirus 6 (n = 1), non-D68 enterovirus (n = 2), rhinovirus (n = 1), Mycoplasma pneumoniae (n = 1), Bartonella henselae (n = 1), and influenza B (n = 1). In total, 32% recovered fully in strength and function, and 45% had full recovery of function. 18% remain completely dependent on caregivers. All extremities were involved in 8 patients. 6 had significant residual weakness, ranging from flaccidity in one extremity to complete caregiver dependence. One was lost to follow-up after discharge. None of the three patients with Enterovirus D-68 made a full recovery, and all three remain largely dependent on caregivers. Treatments varied, but most commonly included methylprednisolone (n = 14) or intravenous immunoglobulin (IVIG) (n = 13). All cases of full recovery were treated with steroids, IVIG, or both. 4 patients were not treated; 2 with eventual recovery of function (Figure 1). Response to IVIG and steroids was variable; no harm was noted in response to IVIG (Figure 2). Conclusion Our findings overall show more promising outcomes than those seen in the 2014 nationwide outbreak of AFM. Specific treatments were not associated with better outcomes. IVIG appeared to be helpful in several cases and, at the very least, was not harmful. Patients with all extremities involved and/or enterovirus D68 appear to have poorer outcomes. Disclosures All authors: No reported disclosures.

Spark plasma sintering has been used for the first time to prepare the ASTM F75 cobalt–chromium–molybdenum (Co–Cr–Mo) orthopaedic alloy composition using nanopowders. In the preliminary work presented in this report, the effect of processing variables on the structural features of the alloy (phases present, grain size and microstructure) has been investigated. Specimens of greater than 99.5 per cent theoretical density were obtained. Carbide phases were not detected in the microstructure but oxides were present. However, harder materials with finer grains were produced, compared with the commonly used cast/wrought processing methods, probably because of the presence of oxides in the microstructure.

Hypertrophy of the optic nerves and optic chiasm is described in a 5-month-old boy with infantile Krabbe disease. Optic nerve and optic chiasm hypertrophy is a rarely described feature of Krabbe disease. The areas of the prechiasmatic optic nerves and optic chiasm were measured and compared with those of 26 age-matched controls. The areas of the prechiasmatic optic nerves and optic chiasm were 132% and 53% greater than normal, respectively.